Community Support Groups Deliver HIV Treatment in Mozambique

When resources are limited, community support groups can help expand access to HIV treatment and keep people engaged in care. One country where the promise of community support groups has already been demonstrated is Mozambique, one of the most severely affected countries by HIV in the world.  Roughly 1.5 million people in Mozambique are living with HIV and nearly 40,000 people die from the disease each year.

Since 2004, CDC, through the U.S. President’s Emergency Fund for AIDS Relief (PEPFAR), has worked to expand access to HIV treatment in Mozambique. Through this effort, 800,000 people have received live-saving HIV antiretroviral treatment (ART). While the scale-up of ART in Mozambique has resulted in fewer deaths from HIV, CDC and its partners have encountered many barriers to keeping patients in care. CDC has developed strategies to improve retention in ART for people living with HIV.

It was common for people with HIV in Mozambique to travel two to three hours to the closest health care facility, and spend up to eight hours waiting to see a clinician and receive their medicines. To help increase ART health facilities and reduce wait times, the Mozambique Ministry of Health worked with CDC to expand prescribing responsibilities beyond physicians for ART medications to include nurses and physicians assistants.

In 2010, CDC and its partners led a national effort in Mozambique to increase access to ART – community ART support groups (CASGs). CASGs are small groups of patients from the same community who each take turns collecting the group’s medications from the health facility and distributing the treatments at community locations convenient for group members to access. CASGs provide a support system and reduce the burden on patients by reducing travel costs and time spent at the clinic waiting on prescription refills.  

A new CDC study examining the first decade of ART scale-up in Mozambique (2004 to 2013) and participation in CASGs from 2010 to 2013 found that CASG participants were significantly more likely to stay on treatment than non-CASG participants. Full results of the study, the first nationwide analysis of CASGs, were published in the October 2016 Journal of Acquired Immune Deficiency Syndromes (JAIDS). The new study and previous research have prompted a shift in Mozambique’s national HIV treatment strategy, which now recommends expanded scale-up of CASGs. In April 2016, almost 65,000 people with HIV were participating in CASGs in Mozambique.

The CASG treatment delivery model is increasingly being used to reach the UN’s 90-90-90 targets by 2020, which call for 90 percent of people living with HIV to know their status, 90 percent of those diagnosed to start and stay on ART, and 90 percent of those on ART to have a suppressed viral load.

With the potential to increase retention in ART, CDC is piloting CASGs in other countries. Zambia is launching this effort in three districts, with support from CDC. Namibia and the Democratic Republic of Congo introduced CASGs in a handful of districts, and are now working with CDC and partners to expand this effort. CDC is developing plans for implementing CASGs in Kenya and Tanzania, and exploring multiple-month prescription refills in Tanzania. 

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